A cortically-weighted versus total Alberta Stroke Program Early Computed Tomography Score in thrombectomy outcome...

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Subcortical infarct scoring using the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) presents challenges with inter-reader variability.
• Predicting functional outcomes after thrombectomy is crucial for patient management.

Purpose of the Study:

• To compare the predictive performance of a novel 7-point cortically-weighted ASPECTS with the standard 10-point ASPECTS for functional outcomes following mechanical thrombectomy.
• To evaluate the reliability and potential simplification offered by the 7-point score.

Main Methods:

• Prospective data from 328 patients undergoing thrombectomy for M1 MCA or ICA occlusions were analyzed.
• Two multivariate proportional odds models were developed using either 10-point or 7-point ASPECTS to predict 90-day modified Rankin score.
• Model performance was compared using receiver operator characteristics and information criteria.

Main Results:

• No significant difference in predictive performance was observed between the 10-point and 7-point ASPECTS models (p=0.14).
• The cortically-weighted score model achieved 50% correct classification, while the total score model achieved 56% in the validation cohort.
• Both scoring systems demonstrated comparable ability in predicting functional outcomes.

Conclusions:

• The 7-point cortically-weighted ASPECTS is a non-inferior and potentially more reliable, simplified alternative to the traditional 10-point ASPECTS.
• This simplified score has potential applications in the development of automated image analysis tools for stroke assessment.
• The findings suggest a move towards more streamlined scoring systems in acute stroke imaging.